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Reimbursement Request Form definition

Reimbursement Request Form means the form set forth in Exhibit C attached hereto.
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Reimbursement Request Form means the form set forth in Exhibit C hereof.
Sample 1Sample 2
Reimbursement Request Form means the form set forth in Exhibit C attached
Sample 1

Examples of Reimbursement Request Form in a sentence

  • When you elect to have your designated vendor administer your Account-Based Offerings, Blue Cross and Blue Shield will provide services in accordance with the Claim Reimbursement Request Form you provide to Blue Cross and Blue Shield for services under this Account-Based Offerings Administrative Services Agreement.

  • When you elect to have Blue Cross and Blue Shield work with your designated vendor for your Account-Based Offerings, you will provide Blue Cross and Blue Shield with a completed Claim Reimbursement Request Form that designates certain aspects of the Account-Based Offerings that you will make available to your eligible employees.

  • This Account-Based Offerings Administrative Services Agreement will be considered accepted and binding by the parties when you sign your Group Setup Form or, when applicable, your Claim Reimbursement Request Form, or you pay your first month’s service fees for Account-Based Offerings.

  • When you elect to have Blue Cross and Blue Shield work with your designated vendor for your Account-Based Offerings, Blue Cross and Blue Shield will provide services as described in this Account-Based Offerings Administrative Services Agreement and in your Claim Reimbursement Request Form.

  • Blue Cross and Blue Shield will administer these services in accordance with the terms and conditions of this Account-Based Offerings Administrative Services Agreement, your Group Setup Form and Fee Schedule or, when applicable, your Claim Reimbursement Request Form and Fee Schedule, and the Business Associate Agreement which is included as Attachment 3 to the Premium Account Agreement.

  • Individuals or Member Fraternities conducting business on behalf of the IFC may request a reimbursement for their expenses utilizing the IFC Reimbursement Request Form.

  • Individuals or member chapters conducting business on behalf of the IFC may request a reimbursement for their expenses utilizing the IFC Reimbursement Request Form.

  • Health Care Spending Account (HCSA)• If you do not use your Citigroup FlexDirect debit card, you can file a claim by using the HCSA Reimbursement Request Form.

  • The Superintendent will sign the SMCPS Tuition Reimbursement Request Form, indicating approval or denial, and return the signed form to the employee within ten workdays of its receipt in the Department of Human Resources.

  • Such expenses should be reported for reimbursement on the Monthly Local Mileage and Expense Reimbursement Request Form.


More Definitions of Reimbursement Request Form

Reimbursement Request Form means the form set forth in Exhibit C which is attached hereto and made a part hereof.
Sample 1

Related to Reimbursement Request Form

  • Disbursement Request means a disbursement request from the Borrower to the Administrative Agent and the Collateral Agent in the form attached hereto as Exhibit C in connection with a disbursement request from the Unfunded Exposure Account in accordance with Section 2.04(d) or a disbursement request from the Principal Collection Subaccount in accordance with Section 2.18, as applicable.

  • Advance Request Form means a certificate, in a form approved by Lender, properly completed and signed by Borrower requesting a Revolving Credit Advance.

  • Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract.

  • Direct Debit Request means the Direct Debit Request between Us and You.

  • Request for Payment means a payment application or declaration of expenditure submitted by the Member State to the Commission;

  • Draw Request Any request by the Borrower, pursuant to Section 2.2 of this Agreement, for a disbursement of any portion of the proceeds of the Loan.

  • Payment Date Advance Reimbursement has the meaning set forth in Section 8.03(a)(iii)(A) of the 20[•]-[•] Servicing Supplement.

  • Request for Advance means a Request for Revolving Credit Advance or a Request for Swing Line Advance, as the context may indicate or otherwise require.

  • Investment Request means a letter in substantially the form of Exhibit A hereto executed and delivered by the Seller to the Administrative Agent and the Purchasers pursuant to Section 2.02(a).

  • Support Request means a request for assistance received by Blackboard's Service Desk and/or Service Desk Infrastructure from an Authorized User, such as any answered phone call, answered email, or answered chat.

  • Application for Payment means Contractor’s monthly partial invoice for payment that includes any portion of the Work that has been completed for which an invoice has not been submitted and performed in accordance with the requirements of the Contract Documents. The Application for Payment accurately reflects the progress of the Work, is itemized based on the Schedule of Values, bears the notarized signature of Contractor, and shall not include subcontracted items for which Contractor does not intend to pay.

  • Request for Letter of Credit means a written request for a Letter of Credit substantially in the form of Exhibit H, signed by a Responsible Official of Borrower, and properly completed to provide all information required to be included therein.

  • Payment/Advance Form is that certain form attached hereto as Exhibit B.

  • Application Form means any application form to be completed by subscribers for Shares as prescribed by the Company from time to time.

  • Disbursement Schedule means the disbursement schedule as set out in an FAA;

  • Funding Request shall have the meaning set forth in Section 5.3(a).

  • LC Request a request for issuance of a Letter of Credit, to be provided by Borrower Agent to Issuing Bank, in form satisfactory to Agent and Issuing Bank.

  • Request for Loan means a written request for a Loan substantially in the form of Exhibit E, signed by a Senior Officer of the applicable Borrower and properly completed to provide all information required to be included therein.

  • Bid Application Form means the form as specified in Annexure II of this E-Auction Process Information Document;

  • Reimbursement Date shall have the meaning provided in Section 3.4(a).

  • Reimbursement Payment shall have the meaning given to that term in Subparagraph 2.02(c).

  • Account Application Form means the Personal Account Application Form for International Personal Banking or Wealth and Investment as applicable;

  • Special Instruction Form means a standardized form prescribed by the Management Company to be duly filled by the investor to change his/her particulars and will be stated in this Offering Document.

  • Request for Applications (RFA) means the document (including all exhibits, attachments, and published addenda), issued by the System Agency under which applications for grant funds were requested, which is incorporated by reference in the Grant Agreement for all purposes in its entirety.

  • Reimbursement Amount As defined in Section 2.04.

  • Advance Request means a request for an Advance submitted by Borrower to Lender in substantially the form of Exhibit A.

Most Referenced Clauses

Most Referenced Definitions